MomeGalen® / Nasonex® (mometasone nasal)

MomeGalen® and Nasonex® are nasal corticosteroid sprays containing the active ingredient mometasone furoate. Mometasone is approved both for allergic rhinitis and for nasal polyps (nasal polyposis).

Mometasone furoate has high local potency in the nasal mucosa combined with very low systemic bioavailability (below 1% with nasal use).

MomeGalen® is the generic, Nasonex® the original product. Both contain the active ingredient in identical doses.

Mometasone furoate acts as a potent glucocorticoid in the nasal mucosa:

Mechanism of action:

• Binds to intracellular glucocorticoid receptors
• Inhibits the formation of inflammatory mediators (prostaglandins, leukotrienes)
• Reduces the infiltration of eosinophils, basophils and mast cells
• Suppresses the allergic inflammatory response in the nasal mucosa
• Has a decongestant effect on the mucosa

Effect on nasal polyps:

• Reduces the size of nasal polyps
• Improves nasal breathing

Onset of action:

• First improvement often after 12 hours
• Clinically relevant effect after 1–2 days
• Full effect after 1–2 weeks of regular use

Mometasone nasal is suitable for:

• Adults and adolescents aged 12 years and older with allergic rhinitis
• Children aged 3 years and older (seasonal and perennial rhinitis, when prescribed by a doctor)
• Adults aged 18 years and older with nasal polyps
• Seasonal and year-round allergies

Particularly recommended for:

• Nasal congestion as the main symptom
• Nasal polyps obstructing nasal breathing
• Long-term therapy
• Children (approved from 3 years of age)

Not suitable for:

• Untreated nasal infections (fungi, bacteria)
• Nosebleeds or recent nasal injuries
• Tuberculosis of the respiratory tract

Allergic rhinitis – adults and adolescents aged 12 years and older:

• 2 sprays per nostril once daily (= 200 µg total dose)
• Maintenance dose: 1 spray per nostril once daily (= 100 µg)

Allergic rhinitis – children 3–11 years:

• 1 spray per nostril once daily (= 100 µg)

Nasal polyps – adults aged 18 years and older:

• Starting dose: 2 sprays per nostril once daily (= 200 µg)
• If not adequately improved after 5–6 weeks: 2 sprays per nostril twice daily (= 400 µg)
• After improvement: the lowest dose that keeps your symptoms under control

Available strength:

• 50 µg mometasone furoate per spray (140 sprays per bottle)

Prophylactic use:

• Start 2–4 weeks before the expected start of the pollen season

How to use:

• Gently blow your nose
• Shake the bottle
• Remove the protective cap
• Insert the nozzle into the nostril (pointing away from the septum)
• Pump once while breathing in gently through the nose
• Breathe out through the mouth

Important notes:

• Before first use: pump 10 times (until a uniform spray mist appears)
• If not used for > 14 days: pump 2 times
• Use regularly for optimal effect
• Clean the spray tip weekly with warm water
• Do not spray toward the nasal septum

Tips:

• Left hand for the right nostril, right hand for the left nostril
• Tilt your head slightly forward
• For nasal polyps: use consistently, even when improvement occurs

Mometasone nasal must not be used in cases of:

• Hypersensitivity to mometasone furoate or any of the other ingredients
• Untreated local infection of the nasal mucosa
• Nasal surgery or nasal injury that has not yet healed

Caution in cases of:

• Active or latent tuberculosis
• Herpes simplex of the eyes
• Systemic fungal infections
• Long-term use in children (growth monitoring)
• Concomitant use of other corticosteroids (inhaled, dermal)
• History of glaucoma or cataract

Pregnancy and breastfeeding: May only be used after a strict benefit-risk assessment. Systemic absorption is minimal (< 1%). With long-term use during pregnancy: monitor the newborn for adrenal insufficiency.

Common (1–10%):

• Nosebleeds (epistaxis)
• Pharyngitis (inflammation of the throat)
• Headache
• Burning or irritation in the nose

Frequency not known:

• Taste or smell disturbances
• Nasal septum perforation
• Hypersensitivity reactions (angioedema, bronchospasm)
• Increased intraocular pressure, glaucoma, cataract (with long-term use)

Systemic side effects: With nasal use as directed, systemic corticosteroid effects are not expected. Mometasone has a systemic bioavailability of below 1%.

Children: With long-term use: regular monitoring of height growth is recommended, although studies showed no significant impairment of growth.

Caution with:

• Ritonavir and strong CYP3A4 inhibitors (could theoretically increase systemic mometasone exposure)
• Other corticosteroids (inhaled, oral, dermal – additive cortisol suppression)

No relevant interaction with:

• Oral antihistamines (safe combination)
• Loratadine (investigated in studies – no interaction)
• Leukotriene antagonists (montelukast)
• Decongestant nasal sprays (short-term)

Note: Due to the extremely low systemic bioavailability of mometasone nasal (< 1%), systemic drug interactions are very unlikely.